Rate-Control Treatment and Mortality in Atrial Fibrillation
Background—Current American and European guidelines emphasized the importance of rate control treatments in treating atrial fibrillation (AF) with a Class I recommendation, although data about the survival benefits of rate control are lacking. The goal of the present study was to investigate whether patients receiving rate control drugs had a better prognosis compared to those without rate-control treatment.
Methods and Results—This study used the "National Health Insurance Research Database" in Taiwan. There were 43,879, 18,466 and 38,898 AF patients enrolled in the groups of beta-blockers (BBs), calcium channel blockers (CCBs) and digoxin, respectively. The reference group consisted of 168,678 subjects who did not receive any rate-control drug. The clinical endpoint was all-cause mortality. During a follow-up of 4.9±3.7 years, mortality occurred in 88,263 patients (32.7%). After the adjustment for the baseline differences, the risk of mortality was lower in patients receiving BBs (adjusted hazard ratio [HR] = 0.76, 95% confidence interval [CI] = 0.74-0.78) and CCBs (adjusted HR = 0.93, 95% CI = 0.90-0.96) compared to those who did not receive rate-control medications. On the contrary, the digoxin group had a higher risk of mortality with an adjusted HR of 1.12 (95% CI = 1.10-1.14). The results were consistently observed in subgroup analyses and among the cohorts after propensity matching.
Conclusions—In this nationwide AF cohort, the risk of mortality was lower for patients receiving rate-control treatments with BBs or CCBs, and the use of BBs was associated with a largest risk reduction. Digoxin use was associated with greater mortality. Prospective randomized trials are necessary to confirm these findings.
- Received October 10, 2014.
- Revision received July 25, 2015.
- Accepted August 10, 2015.